Hodges' conceptual framework: A model for Narrative Medicine ...

Abstract

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care. ...

 

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897 

With my emphasis.

#Identity #Group #Individual #Collective #Mind #Body #TheOdysseyHasBegun

"Train midwives as nurses" - Ockenden

Re. Ockenden Report

Catching up on the newspapers, I noticed in the Times reporting of Ockenden calling for midwives to train as nurses first. Provoking debate about nurse education.

Within maternity services there are problems with continuity of care and skills in dealing with complex cases:

'Maternal Deaths 

60. The Review examined 27 maternal deaths that occurred between 2006-2024. Five cases fell outside of the Terms of Reference of the Review. Of the 22 remaining cases, reviewers identified failures in care that may have or substantially impacted on the outcome in six deaths. 

61. The profile of maternal deaths at NUH over this period broadly aligned with the known demographics and causes as identified by MBRRACE. 11 of the deaths occurred to women living in the most deprived areas of the city and 14 occurred amongst women who were not white British.

62. The common failures reviewers identified that might prevent future maternal deaths included: listening to women and families and acting promptly on concerns; continuity of care particularly for those with additional social/medical complexities; robust clinical governance to ensure timely information sharing across organisations and prompt access to imaging for women presenting with concerning neurological symptoms.' xiv

AI Overview (Ecosia) suggests that although direct entry to midwifery has always been possible(?), the English National Board created the pathway some 39 years ago.

The Ockenden Report describes how in combination health systems, culture, leadership and training can contribute to compassion fatigue (p.313).

When you look at Hodges' model and our languages, a great many challenges for curricula, training and education programmes can be found. The most powerful of what can be progressive, or threats are invariably mechanistic:

• shorten
• bypass
• shortcut
• cutting corners
• short-circuit

Nursing must always move forward, continuous professional development is built on this principle. In the late 70s and 1980s post-registered qualifications were held in high esteem. Especially midwifery, paediatrics, health visiting, emergency and intensive care. 

Clearly, decision and policymakers can underestimate the value of basic nurse training. Having an idea since childhood is brilliant, but at interview saying you're compassionate and want to make a difference will soon be tested. Sometimes as a student rather bluntly, as with a first placement in forensic nursing. I wonder how many students have been lost there? I'm sure the majority will cope, manage, enjoy and prosper, but I've seen the student peers who miss these cohort members on subsequent learning experiences. What preparation is employed?

Basic nurse training, is just that. Demonstrating competence in communication, awareness of basic needs and how these are expressed behaviourally. What interpersonal skills and knowledge are needed. As highlighted before, the director of nurse education worried about those of us who worked as nursing assistants risked being trained in poor care. Not recognising 'bad practice', a 'poor attitude', not using observation and most important of all listening: to what is said and unsaid. When I started I remember thinking about not responding - as individually programmed to do so, through a reflex action. That was a worry back then. 

While the news in the Ockenden Report is bleak. The depth of the report (for me) is manifest in identification of not only socioeconomic factors, but sociotechnical too (with five mentions) and the critical interplay of seeing (and hearing!) the individual amid the collective:

'2. Fetal monitoring

Rather than reflecting simple failures of individual interpretation, growing evidence suggests that intrapartum fetal monitoring is best understood as a complex sociotechnical practice, shaped by system design, workload, team dynamics, guideline variability and organisational culture.119 Continuous CTG itself has well-recognised limitations, including poor specificity for predicting long-term neonatal outcomes and substantial inter- and intra-observer variation in interpretation.5 Reviews of intrapartum care are therefore unavoidably influenced by retrospective bias, with greater apparent clarity afforded by knowledge of the outcome than was available to clinicians at the time. 

However, despite this, a sociotechnical understanding does not negate the importance of examining individual cases in which intrapartum monitoring was demonstrably substandard. National inquiries and confidential reviews repeatedly describe cases involving sustained failure to recognise pathological fetal heart-rate patterns, delayed escalation despite repeated triggers, and missed opportunities for timely intervention. 2,3,120,121 These cases cannot be explained solely by the inherent limitations of CTG or by hindsight bias.' p.143.

It is quite shocking to hear this conclusion: the need to train as a nurse first. Counterarguments: where is the evidence(?!) - have followed. But then if you undervalue and miss the fundamentals (see Hodges' model!) then individuals, families, communities, students, practitioners, services and systems suffer.

Previously: 'maternity' : 'report' : 'safety'

vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now. 

iv Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

After a first mention on page 23, it is chapter 6 that discusses "awe" - the chapter's title. I wrote (in light pencil!) 'It keeps you going'. This is deeper than job satisfaction, but in healthcare is a contributing factor. And different again to (clinical) intution (with many mentions), which recurs, despite (or due to) its subjective nature.

Within its 3.5 pages you will find 'interpersonal awe', Piaget's 'accomodation', the neuroscience of awe, and humility. From a physiological and experiences with short-sightedness and vision, I have applied the concept of accommodation over the years. All this, quite rightly, places emphasis upon the therapeutic relationship. Even since the book's publication in 2023, this relationship has grown in importance.

'The sense of awe is an emotional reaction to events characterized as "vast" or to experienced stimuli outside the domain of the usual and prototypical. A sense of "awe" is often described by scientists who peer through telescopes (immensity) or who observe the uniqueness and expansiveness of the microscopic world. A similar emotional reaction can ocur with respect to the overwhelming experience of the clinician processing the complexity of intertwined variables experienced with a patient. When interpersonal awe occurs, it potentially opens the mind of the clinician to enhanced information gathering, cognitive processing, and empathic understanding.' p.49.

I often feel obliged to apologise that the spiritual does not have a concrete home in Hodges' model. Personally, it is INTRA- and interpersonal. Our religious beliefs, and committments were they apply. Unfortunately, the spiritual is often expressed politically: 'shock and awe'(?). Socially, the spiritual is manifest in the world's religions, our cultures and upbringing, recognition of others - in our communities, the media, ability to 'see' beauty, experience empathy, rapport and shared emotions. On twitter I've often written -

(SPIRITUAL [Intra- Interpersonal; Sciences; Political; Sociology] )

So, Hodges' model is embedded within - should be viewed as surrounded by the spiritual. 

Chapter 7, 'Clinical Decision-Making' utilises the thought of Daniel Kahneman. I like the use of ratiocinations here. I do try to bear in mind the 'traps' afforded by Hodges' model. To be clear, it is not the only clinical cognitive tool I have used. For some reason, against ratiocinations I scribbled 'running the axes, or the corridors of care'. Formal training brought to mind training to assure the marking of student's work (if still needed!), and mentoring student nurses. Case-based learning features here, and in the conclusion: CBL 'will be the central element of this book and will involve actual patients with pronounced biopsychosocial complexities.' p.56. How I wish there was an extra reference (a #16) here: clinical decision-making is fundamentally political; both reflectively and reflexively.

Part V then begins (p.59) on further technical considerations with chapter 8 Introduction to Clinical Complexity. A shift is flagged from a linear, logical-based approach to mix of logic and clinical content. At two pages I did hope for more: biological complexity and resolution left me hungry for more. There is however a key learning point on p.62, re. resolution; that of suffering. Connected to this and a well made point is priorities and what is clinically important and any contrast for the clinical team and the patient.

In a BASIC program from the 1980s on the 'Nursing Process' (essentially p.11 in the book, and somewhere on W2tQ?) I'd included a woman, medical ward with chest pain, who was agitated and couldn't explain herself that well. It wasn't delerium, but we eventually found out she was alone at home and worried about a cat. Attention and listening are not in the index, but should be in all clinical texts. An essential ingredient in the aforementioned reflective/reflexive aspect of interpersonal exchange. In the summary for C8 it was good to read of constellations. Our forebears joined the stars to provide meaning and explanation for what was life, being and experience for them, who had passed, and who was to follow. Without that political domain, the meaning is incomplete, may be repeatedly mistaken. How impoverished [we are / are we] as a result?

 Chapter 9 starts to present the clinical model, with clinical illustrations - case examples. The focus here is underrepresented factors. There is always an issue about granularity in how much data/information is needed for a comprehensive assessment/evaluation. A paragraph considers The problem of simplication. A question is raised:

'How can a clinician think of all the contributing factors on the spur of the moment, the point at which many if not most clinical decisions are made? Our guess is that your response, as a reader, may be to wipe your brow and decide to return to "treatment as usual." reverting to comfortable algorithms.' p.67.

This 'treatment as usual' is surely institutional in origin? Back to the 'political' again. Well I can think of a way to frame, apprehend all the contributing factors and on the spur of the moment. Healthcare is inherently situated. Healthcare professionals need to proceed with care, especially with constant reference to statistics and algorithms. Hodges' model can provide an anchorage, a safe harbour even if the visit is fleeting. These harbour fees, or dues, service charges are negligible.

 In Chapter 10 brings the complexcity of the clinical "field", once more through a case illustration, a woman with chronic schizophrenia, complexity based on clinical diagnosis. The process of diagnosis (and a medical matter) is largely a matter of data reduction, a means to simplify, and provide an avenue to aggregate and group. There is a history lesson in the development of hospitals, even as in the UK bed numbers have seen whole scale reductions. Interestingly (for further study), of course, diagnosis is also a way to abstract away details. The problem is that although this makes the unknown a known, it is binding when it comes to complexity. It ties down a flux, a dynamic that doesn't just want to be free it is constantly changing and may also achieve a more ordered state. The authors try to get to grips with this, they highlight housing, employment, comorbidity and how these may prevent recovery. All this as they seek to define complexity in clinical terms. No easy task: itself part of the problem.

In the summary for chapter 10 it was encouraging to see the cultural aspects for the person and group emphasised, plus how identical demographic factors can still result in disimilar prognoses, hence the importance to 'see' the person and their respective 'self-management'. 

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Slingshot AI? Meet the Earthshot (Prize ...!)

Slingshot AI

Ash
"the first AI designed for therapy" 

'In January 2024, we set out to build a 
foundation model for psychology. 

The mental health crisis sweeping across 
our communities isn’t going anywhere, 
and what we’re doing clearly isn’t enough. 
Therapists have one of the hardest jobs in the world,
and there just aren't enough people 
or resources to help everyone in need.
And we all know in our hearts that everyone 
could use some help with their mental health. ...'

'We need a foundation model for psychology.'

 

🔷 

 

Plus a bit more ...? 

 

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

The four primary therapeutic approaches used by Ash are: Cognitive Behavioral Therapy (CBT): Focuses on identifying and modifying dysfunctional thoughts, emotions, and behaviors. Dialectical Behavior Therapy (DBT): Teaches skills for emotion regulation, distress tolerance, and interpersonal effectiveness. Acceptance and Commitment Therapy (ACT): Focuses on accepting difficult emotions while committing to actions that align with personal values. Psychodynamic Therapy: Explores unconscious patterns and early life experiences to understand current behaviors. [ Google AI Overview* ]

?

?

?

Our 'Intelligence' is embodied.
The whole of Hodges' model is / can be 
embodied - embedded within the SPIRITUAL.

My source: Electronic therapy - Machines of loving grace, The Economist, November 15th-21st, 2025. Vol. 457: #9474. pp.72-73.

 *"slingshot ai - what are the four therapeutic approaches used by ash?"

 

Previously: 'health' : 'ai' : 'parity of esteem' : 'foundation' : 'language' : 'embodied'

Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht

The canalization of a river 
The grafting of a fruit tree 
The education of a person 
The reconstruction of a state. 
These are all instances of a fruitful critique 
And they are also
 Instances of art. 
—Bertolt Brecht, “On the Critical Attitude”

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'The education of a person'	'The canalization of a river The grafting of a fruit tree'
'These are all instances of a fruitful critique And they are also Instances of art.' —Bertolt Brecht, “On the Critical Attitude”	'The reconstruction of a state.'

MacGregor, W., Horn, M. & Raphael, D. Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht. J Med Humanit 45, 53–77 (2024). https://doi.org/10.1007/s10912-023-09801-5

My source: 

Politics of Health Group Mail List Messages
Visit PoHG on Facebook: https://www.facebook.com/282761111845400
Follow us on Twitter: @pohguk
You can subscribe to / unsubscribe from the PoHG mail list here: http://www.jiscmail.ac.uk/POHG
And SDOH list - https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1

See also: 'drama' : 'empathy' : 'poetry' : 'change' : 'art'

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Mind the Inclusion Gap: How Allies Can Bridge the Divide Between Talking Diversity and Taking Action

by Suzy Levy
https://policy.bristoluniversitypress.co.uk/trade/mind-the-inclusion-gap?utm_source=signature&utm_medium=signature&utm_campaign=BUP-email-signature 

White Privilege: The myth of a post-racial society

by Kalwant Bhopal
https://policy.bristoluniversitypress.co.uk/trade/white-privilege-1?utm_source=signature&utm_medium=signature&utm_campaign=BUP-email-signature 

Our charity for 2025 is Bristol Refugee Rights. Find out more and donate here
https://bristoluniversitypress.co.uk/charity?utm_source=signature&utm_medium=signature&utm_campaign=BUP-email-signature

 

My source: https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=EUROPEAN-SOCIOLOGIST

'The Trip' - learning about Kay Parley RIP

Five prompts drew me to BBC Radio's 'The Trip':

1. the ongoing tenor of 'discussion' on twitter;
2. the ongoing history and future development and evolution of psychoactive, psychedelic medicines as treatments, running concurrently, or not with psychotherapy and psychosocial interventions (PSI);
3. being mindful of keeping up-to-date;
4. what is the temperature within critical psychiatry / mental heath / mental illness / well-being?
5. and how does all this 'sit' within Hodges' model?

As a student registered mental heath nurse, we learned about the historical introduction of chlorpromazine and other drugs, the difference they made to 'care' and the side-effects.

Pharmacology is dynamic. Atypical antipsychotics are now available. But this series, as the title confirms is about psychedelics and history from 08:30.

The episode highlights the importance of how sessions are delivered. Key points, given the additional pressures (UK) upon intakes for student nurse places for learning disability and mental health, plus questions about the status of these courses within university-based nurse education. If not already aware, the episode concludes with the role of a mental health nurse who died in May. Have a listen about Kay Parley.

THE TRIP - BBC Radio

https://www.bbc.co.uk/sounds/play/m002gqxs

It would have been marvellous to meet, speak to Nurse Parley. The episode has it's objectives of course, but there are values here. We are all test pilots, researchers.

"The American Journal of Nursing February 1964:

No role, is so welcomed on our psychiatric unit, as that of sitting with a patient during LSD therapy. This indicates that the treatment has value." ...

"Kate Parley passed away in May, so our last words will be hers. Words she would say to her patients at Weyburn, all those years ago.

'You are off on a trip with no baggage, no destination and no compass. That's why I'm here. I can't go with you, but I can be your anchor.

Wherever you go, you'll always be able to see me. I'll be the nurse who sits beside your bed. Taking notes and playing your records.

You'll never lose touch with me. Seeing me, you'll know, you are really in hospital and that you'll be back to Earth about 4 o'clock. I will send you signals too, to encourage your explorations.

I will remind you of places you longed to revisit and events you hope to scan.'"

PARLEY, KAY. Supporting the Patient. AJN, American Journal of Nursing 64(2):p 80-82, February 1964. 

https://www.openurses.org/_files/ugd/52de8b_870deaa149e842d286e76131b1321285.pdf

https://andrewpenn.substack.com/p/in-memoriam-kay-parley-rpn-registered

Todd, Betsy MPH, RN. Supporting the Patient on LSD Day. AJN, American Journal of Nursing 121(6):p 42-44, June 2021. | DOI: 10.1097/01.NAJ.0000753656.16844.a9 

Call for Papers: Compassionate Futures for Collective Well-Being

Despite an academic affiliation, without any (part-time) tutoring hours this past year, it may be difficult to avoid article processing fees (APCs). A shame as I believe that Hodges' model can address this call (below) in a somewhat novel manner. 

If anyone is interested in exploring a writing project framed around Hodges' model and employing a relational - diagrammatic approach please let me know.

The exercise would be greatly enhanced by:

1. Engaging with one of more academics, adept in formal methods (maths, logic..?) and keen to apply their talents within the social sciences - humanities.
2. And, exploring the possibility of working with early career researchers, including from developing nations, independent and 'late career'(!) scholars would also be very welcome.

Previously:

Jones, P. (2004) Viewpoint: Can informatics and holistic multidisciplinary care be harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Jones, P. (2004) The Four Care Domains: Situations Worthy of Research. Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK.

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

Compassionate Futures for Collective Well-Being

Academic Editors: Karin Hannes (KU Leuven) and Natalia Martini (KU Leuven)

Deadline for Abstracts: 15 September 2025
Deadline for Articles: 30 January 2026

Social Inclusion, peer-reviewed journal indexed in the Social Sciences Citation Index (Web of Science; Impact Factor: 1.4) and Scopus (CiteScore: 3.5), welcomes new and exciting research papers for its upcoming issue "Compassionate Futures for Collective Well-Being," edited by Karin Hannes (KU Leuven) and Natalia Martini (KU Leuven).

In an increasingly unequal world, the concept of “compassionate futures” offers a new paradigm to address the pressing challenges of social inclusion. Compassionate futures recognize vulnerability, interdependency, and mutual responsibility as fundamental features of social relations, and emphasize care and empathy as fundamental principles in designing socio-cultural, economic, and political systems where the collective well-being of diverse actors, human and other-than-human, can flourish.

We encourage contributions that engage in an interdisciplinary dialogue among scholars, practitioners, and policymakers about what it means to create a caring society in the face of persistent inequalities. In addition, we welcome papers that demonstrate where and how humans take up the responsibility to conceptualize compassionate futures from a multi-species perspective, as well as those that focus on what hinders or supports the idea and the project of compassionate futures. We accept theoretical papers presenting frameworks on compassionate futures, prospective policy analyses, cases featuring the use of futures studies and co-creative approaches that promote compassion and care as central principles in re-imagining the future, and reflection papers focusing on global cooperation for fostering compassionate futures. Authors should connect to the general idea of how humans could or should relate to other agents with whom they share the planet or illustrate how the new narratives they developed support collective well-being.

Authors interested in submitting a paper to this issue are encouraged to read the full call for papers here:

https://www.cogitatiopress.com/socialinclusion/pages/view/nextissues#CompassionateFutures

Abstracts welcome until 15 September 2025.

Kindest regards,

Mariana
Mariana Pires
Social Inclusion
Cogitatio Press
1070-129 Lisbon 

Portugal

New issues (open access):
Public Participation Amidst Hostility: When the Uninvited Shape Matters of Collective Concern
https://www.cogitatiopress.com/socialinclusion/issue/view/419

Violence, Hate Speech, and Gender Bias: Challenges to an Inclusive Digital Environment
https://www.cogitatiopress.com/socialinclusion/issue/view/415

My source: https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=COMPLEXITY-PRIMARY-CARE

The mask ...

'I will speak from my experience with Balinese masks, but I have to go back one step before that. One of the first, knockout exercises that you can do with actors, which is used in lots of theatre schools where they use masks, is putting a plain, blank, white mask on someone. The moment you take someone's face away in that way, it's the most electrifying impression: suddenly to find oneself knowing that that thing one lives with, and which one knows is transmitting something all the time, is no longer there. It's the most extraordinary sense of liberation.

This is one of those great exercises that whoever does it for the first time counts as a great moment: suddenly to find oneself immediately for a certain time liberated from one's own subjectivity. And the awakening of a body awareness is immediately there with it, irresistibly; so that if you want to make an actor aware of his body, instead of explaining it to him and saying, "You have a body and you need to be aware of it," just put bit of white paper on his face and say, "Now look around." He can't fail to be instantly aware of everything he normally forgets, because all the attention has been released from this great magnet up top.' p.219

self

|

INTERPERSONAL : SCIENCES              

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

|

other

Brook, P. (1989). The Shifting Point. London, UK: Methuen. pb.

Secondhand from Reid's, Mount Pleasant, Liverpool, this book was already 'musty'. On October 18th it got 'wet' in a downpour from Sorrento to Capri and back. It smelt even more historic afterwards. It still provided great reading though! I noticed in a new pb edition the images were not included.  https://reidofliverpool.co.uk/

'Emperor' - Aphasia

individual

|

INTERPERSONAL : SCIENCES              

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

|

group

	'Physical Reality'
Social Reality	'Political Reality'?!

See also:
Mammary Mountain

Impulse

Faber, T. Lessons in empathy, Life&Arts, FT Weekend, October 5-6, 2024, p.13.

Funded PhD in Empathic Healthcare (the only one in the world!)

 Artificial Empathy

Qualification: PhD



Department: School of Healthcare

Application deadline: 7 April 2024

Start date: 23 September 2024

Overview (referenced - see main)

Supervisors

Professor Jeremy Howick (jh815 AT leicester.ac.uk)
Dr Josie Solomon
Dr Amber Bennett-Weston

 
Project description

Empathic healthcare improves patient quality of life and satisfaction with their care while reducing their pain.1,2 Higher levels of practitioner empathy are also associated with lower mortality among diabetic patients.3 Empathy can also reduce practitioner burnout.4,5 Despite its importance, the extent to which patients report that their practitioners are empathic varies widely,6 and medical student empathy appears to decline throughout medical school.7 To address this problem, the Stoneygate Centre for Empathic Healthcare are developing and implementing a revolutionary evidence-based empathy curriculum to the Leicester Medical School, and also to healthcare professionals in the NHS and beyond.

Aims

To develop, deliver, and evaluate research-based educational empathy interventions to medical students and healthcare professionals. 

[NB: While hosted in a medical school, this is not a medical education project per se. The PhD candidates will focus on the research to underpin an evidence-based curriculum.]

continued ...

My source and image:

https://x.com/Empathy_Centre/status/1760690291726762402?s=20

Attending: Active listening c/o Baggini & TPM

Reading through more past issues of The Philosopher's Magazine, I came across Baggini's short contribution of Attending one of "50 New Ideas".

That Hodges' model has a role in attention must follow from its main purpose as an aide-mémoire. To 'know', to recognise that your memory has been jogged is surely to attend.

I realise that Hodges' model represents a philosophical smörgåsbord, rather like the 50 ideas in this issue.^

Baggini draws on a film for inspiration on empathy, feelings for other, humanity and moral philosophy. For Hodges' model our context can encompass media, but the focus remains empathy, ability to relate in the clinical, social care context. Attention and interpersonal skills come the fore here.

If you are not hungry, the model (smörgåsbord) can be considered as empty. This is a precondition for 'attending' - having unconditional positive regard. Apart from information that relates to the patient's, student's, and your safety the domains of Hodges' model are vacant spaces. How they are populated depends on how we attend. There are important lessons for students here. The first is their phone. Its being on their person, may impact their ability to attend to the other (person). The window to outside isn't a screen either.

 Individual
  |

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

previous experience cognitive furniture - elephants in the room (for all?) attend/attending attention active listening authenticity observation empathy - rapport therapeutic relationship unconditional +ve regard I see, I hear you ...	physical space physical environment measurements furniture - layout position / posture observation

Attending needs to be active listening. This includes all the senses, although sniffing the air is probably  best avoided - body odour may announce itself. Attention, then is synonymous with observation and in this context must span an individual's physical and their psychological presentation. You may draw social, political and spiritual assumptions, it is human to do so. Intuition has a role in healthcare but initial conclusions must be recognised as potentially premature and be verified. 

To initiate, be-in, partake-in such situations is to attend to the verbal, and non-communication; the data you already have and information communicated, including in a referral. Is this confirmed, challenged, what is your opinion? What about your colleagues? Most importantly, what does the person (patient, client... say)? What is unspoken? Do you understand? Did you seek clarification? 'Where' have you been / not been in Hodges' model? What picture is emerging at this stage?

It is gratifying that this is the first of the 50 'new' (2016) ideas in TPM #72. 

More to follow - drawing on TPM and (I think, Hodges' model as a 'philosophy? Surely not!)

Baggini, J., Attending, The Philosopher's Magazine, 1st Quarter 2016. Issue 72. pp.21-22.

TPM #72 cover image: https://ericthomasweber.org/correcting-political-correctness/

Empathy - Relating, Knowing, Objects, Patterns ...

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

"Logos is our capacity to separate ourselves from the surrounding world, making it into objects in order to recognize it objectively, reflect about it. Any fully developed human relationship needs both principles, the relating and the knowing. Knowing in this sense means the possibility of discriminating between the common ground and the difference of I and Thou. Without knowing, there is fusion or identity but not relationship between a separate I and a separate Thou." p.64.

"Recently a woman training to be an analyst came for supervision and brought with her for the first time a tape of an analytic session she had had with a woman patient of hers. To our amazement, in listening to this tape, we both had at certain times quite some difficulty in distinguishing her own voice from the voice of the patient. This happened mostly when the patient was talking very softly and obviously fighting to overcome feelings of shame. The candidate felt rather shocked at first and asked me whether she might have identified with the patient in an unhealthy way. I heard her interventions on the tape as being genuinely in tune to the atmosphere and situation of the patient at those moments, so I told her that to my mind she was responding in an empathetic way to her patient. It was apparent that the patient needed this kind of response, for later in the tape one could hear that the patient became more confident in exploring her feelings. I think the candidate reacted to the needs of her patient with a concordant countertransference reaction." p.38.

Jacoby, M. (1984) The Analytic Encounter: Transference and Human Relationship. Toronto: INNER CITY BOOKS.

In this text and other reading I can see a possible means as to how the concept of identity can be used between the Individual - Group (other).

To follow soon:

Book review iii. General Psychotherapy: Principles and Common Theoretical Aspects - Rediscovering Humanity

Ear of Dionysus :: Ear(s) of a Mental Health Nurse*

c/o Archaeological Park of Neapolis

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Interpersonal Communication Skills Active listening	Ear of Dionysus - Syracuse, Peter Jones 29th Sept 2023
The Socio-Politics of 'information'	Secrets, States and Power

Ear(s): we all need to listen; not just in stereo but quadraphonic.

https://www.italia.it/en/sicilia/siracusa/cultural-places/neapolis-archaeological-park

"Shift" c/o Jacqui Symons

"Title: Shift
Artist: Jacqui Symons
Medium: Triptych of Artists’ Books
Year: 2020

Presented as a triptych of artist-books, ‘Shift’ explores three nurses’ individual shifts showcasing the sheer length of each working day through to the complexity and constantly shifting demand on their time, energy, experience, knowledge and empathy. In 2019, Jacqui Symons was artist-in-residence at Central Manchester NHS Foundation Trust. As part of her residency, she shadowed three nurses; the ward sister, a junior sister and a staff nurse, during their 12 and a half hour shifts on an older people’s ward within the hospital. These concertina books chart every minute of these three shifts."

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Shift: 762 Minutes (detail)

Shift: 727 Minutes (detail)

"When opened, each book is almost 200 metres long - they aim to show the sheer amount of hard work and dedication of each nurse and what they achieved during every moment of their busy shifts.  I found three shifts physically, mentally and emotionally exhausting and I was only observing the nurses' work. The book on the right shows the Ward Sister's - the yellow pages charted breaks for eating, drinking and toilet breaks - less than 30 minutes over the duration of 12 and half hours." p.23.

Shift

My source:

"Shift (727 minutes, 762 minutes and 754 minutes)", Artists' Books. PrintMaking Today, Summer 2023, 32:126. p.23.

https://www.cellopress.co.uk/page/printmaking-today

Image and text: c/o and with thanks - Jacqui Symons

https://jacquisymons.co.uk/